Laparoscopic surgery for median arcuate ligament syndrome using real‐time stereotactic navigation
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- Yuki Aisu
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
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- Tomoaki Okada
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
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- Atsuhiko Sumii
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
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- Riki Ganeko
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
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- Ryosuke Okamura
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
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- Tatsuto Nishigori
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
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- Yoshiro Itatani
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
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- Shigeo Hisamori
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
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- Shigeru Tsunoda
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
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- Koya Hida
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
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- Kenji Kawada
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
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- Kazutaka Obama
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
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- Yoshiharu Sakai
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
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<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>In median arcuate ligament syndrome (MALS), a hyperplastic MAL causes compression and stenosis of the celiac artery (CA). The treatment involves releasing the external pressure on this artery by dissecting the ligament. However, it is difficult to identify the artery because of its deep anatomical location. Stereotactic navigation provides real‐time information regarding the surgical instrument's location on computed tomography (CT) images. We utilized this system to overcome the difficulty of anatomical identification.</jats:p></jats:sec><jats:sec><jats:title>Materials and Surgical Technique</jats:title><jats:p>We present a case of aneurysm rupture caused by MALS, which was treated with laparoscopic MAL dissection with real‐time stereotactic navigation. Surgery was performed in a hybrid operating room with three‐dimensional C‐arm CT (Artis Zeego, Siemens) and an installed Curve navigation system (BrainLab). Preoperative CT images were aligned with intraoperative C‐arm CT‐like images and the surgical instrument position was projected onto preoperative CT images. After the left gastric artery isolation, the fibrous tissue surrounding the left gastric artery was dissected toward the CA while confirming the location of the CA and aortic wall using the navigation system. The CA's diameter was dilated from 1.8 to 2.6 mm with intraoperative angiography.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>This is the first report of laparoscopic MAL dissection using real‐time stereotactic navigation. Although navigation setting was time‐intensive, this system helped us understand the anatomical structures and in safely and precisely dissecting the MAL.</jats:p></jats:sec>
収録刊行物
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- Asian Journal of Endoscopic Surgery
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Asian Journal of Endoscopic Surgery 15 (2), 443-448, 2021-09-26
Wiley
